How an epidemic of dreadful sleep is making us dangerous drowsy drivers
Rosie Earle never complained about being rostered on to the first shift of the day in her role as a senior conductor with East Midlands Railway — in fact, she relished an early start.
Newly married Rosie, 27, was so well known for her talent, warmth and infectious enthusiasm that smiling photos of her were frequently used on the company's advertising material.
On the days when she had those early starts, she would leave her husband Alex, 28, a software engineer, asleep in bed at their Lincolnshire home and set out on her routine 30-minute drive to work.
But one morning in September 2021, Rosie found herself in the wrong place at the wrong time.
Driving northbound on the A15 Lincoln Eastern Bypass at 4.30am, she was confronted by a van coming the other way — but drifting on to her side of the road.
Newly married Rosie (pictured with husband Alex), 27, tragically died behind the wheel after Jamie Jackson's, 32, van drifted on to her side of the road
Lincoln Crown Court was later told that even though this section of the road is completely straight — meaning Rosie's car was in clear view — the driver of the van, Jamie Jackson, 32, failed to react.
The van smashed into her car — and Rosie, a bride of just four months, was killed instantly.
The first Alex knew of this was when he awoke to loud banging on the front door — opening it to find grim-faced police officers waiting to bear the awful news that his wife was dead.
'I couldn't take it in,' says Alex. 'I was numb. I just couldn't process the words.'
Alex struggled to make sense of how the crash could have happened. Police told him the van had been on the wrong side of the road, but the driver hadn't been drinking or distracted by his phone, nor had there been any fault with his vehicle.
Instead, as the prosecuting lawyer would later point out during the court case in November 2022 (in which Jackson pleaded guilty to a charge of causing death by dangerous driving): 'The only reason for this tragedy was this defendant falling asleep at the wheel'.
Speaking for the first time since the death of his wife, Alex told Good Health that the entirely avoidable cause of the motorist's poor driving continues to make the tragedy difficult to process.
'When I discovered that Rosie had been killed because someone had got behind the wheel when they were too tired to drive, it made my loss even more terrible,' says Alex, his voice faltering.
'It was so frustrating, so preventable. I've always understood it —every driver should understand it — that you simply don't drive when you're tired or sleep-deprived.'
(Stock Photo) Alex told Good Health that the entirely avoidable cause of the motorist's poor driving continues to make the tragedy difficult to process
Jackson admitted to 'feeling tired' to police while he was driving home from a night shift and revealed he had stopped at services just off the A1 to 'refresh himself' and have a meal before continuing his last 20 miles home, but is thought to have started nodding off soon after.
Alex is sharing Rosie's story to warn motorists of the dangers of driving while feeling excessively tired — a view experts support.
Many believe more could be done to increase awareness about the dangers of driving while sleep deprived — making it akin to drink-driving.
'Driving while tired — so-called drowsy driving — can be as dangerous as drink-driving and therefore the punishment must be equitable; the law must change to make it a specific criminal offence,' says Nick Freeman, a leading road traffic lawyer based in Manchester.
Indeed, sleep problems appear to be reaching near epidemic levels in this country — and it's not just driving ability that is impaired: last week research in the journal PLos One showed that working night shifts can impair memory by up to 79 per cent in adults.
Previous studies have linked poor sleep with everything from heart problems to depression.
Yet just 29 per cent of UK adults get the recommended seven to nine hours' a night, according to the 2022 Need for Sleep study of 4,000 UK adults.
Another survey last week found that 74 per cent of adults have trouble sleeping at least sometimes, 39 per cent often or always, prompting The Sleep Charity to call for the Government to appoint a Sleep Tsar to tackle the UK's sleep problem.
Professor Guy Leschziner, a consultant neurologist at Guy's and St Thomas' Hospital in London, says: 'At least one in ten Britons suffers with chronic insomnia — defined as difficulty getting to or staying asleep most nights for more than three months — while a third of us frequently suffer from poor sleep (essentially where we wake up not feeling refreshed).
'Good sleep relies on so many factors. If you are sleeping less than six to seven hours' a night you may well be sleep-deprived, and this will affect so many aspects of your health and daily life — including how you drive'.
The impact of tiredness on our ability to drive safely is seismic.
Between 10 and 20 per cent of all crashes in the UK are caused by driver fatigue, according to the road safety charity Brake.
A 2018 study by the AAA Foundation for Traffic Safety in the U.S. found that people who get behind the wheel after less than four hours' sleep are as likely to be involved in a car crash as a drunk driver.
And these motorists' 'crash risks' of making mistakes on the road were similar to drivers with blood alcohol concentrations of 0.12 — which is 1.5 times the legal limit (which is 0.8 — or 80mg of alcohol per 100ml of blood).
Yet while there is a drink limit for driving — and indeed a breathalyser test that measures how much alcohol is in breath — there is no such test for sleep and tiredness.
But now Australian scientists may have come up with a solution: a roadside blood test to detect motorists who are too tired to drive. The research by the Australian Government Office of Road Safety, published in May, identified five biomarkers in blood that can detect whether somebody has been awake for 24 hours or longer.
Preliminary tests show the test can be up to 90 per cent accurate.
While more research is needed —including deciding an agreed threshold to indicate tiredness — such a test could be ready within two years, according to Clare Anderson, an associate professor of psychology at Monash University, Melbourne, who was involved in the research.
(Stock Photo) Alex is sharing Rosie's story to warn motorists of the dangers of driving while feeling excessively tired — a view experts support
This could help spot 'drowsy driving' and help to prosecute people who are too tired to drive.
'We don't have good tools or techniques for assessing whether someone is safe to drive from a sleep perspective,' says Professor Leschziner, 'so such a tool would be welcomed if it was proven to be accurate.'
Signs that you are too tired to drive include yawning repeatedly, heavy eyelids and rubbing your eyes, feeling restless and irritable, difficulty focusing, as well as daydreaming or wandering thoughts, trouble remembering the last few miles driven, or missing exits or traffic signs and drifting from your lane or driving over rumble strips.
Professor Anderson adds: 'When you look at the major killers on the road they are alcohol, speeding —and fatigue. But even though the solution to fatigue is quite simple — to get more sleep — our capacity to manage how much we get is impaired.'
Driving — however familiar we are with a road — requires a high level of concentration and coordination, says Professor Leschziner, and yet an added complexity is that driving itself can 'provide the perfect environment to induce sleep'.
'Driving can be monotonous. The environment inside the car might be warm, comfortable and settled — all of which is conducive to exacerbating drowsiness,' he says.
'The problem is that we are not always good at identifying how tired we are.
'For example, if, as a driver, you start having to open the window or turn up the music — as I hear from people all the time — these are things we do to help us stay awake and indicators that you should not be driving,' he says.
'We need to take tiredness in terms of driving more seriously.'
So how rested should you be before you get behind the wheel? Earlier this year a study published in the journal Nature and Science of Sleep found that having less than five hours' sleep a night makes you just as likely to have a vehicle crash as if you were over the legal limit for alcohol.
Meanwhile, 2018 research by RMIT University in Australia found the natural vibrations of cars make people sleepier, affecting concentration and alertness levels just 15 minutes after drivers get behind the wheel.
'Couple that with our body's natural circadian rhythm — 24-hour cycles that are part of the body's internal clock — and this can make certain times of day, like late nights and early afternoons, feel like a siren song to slumber,' says Dr Katherine Hall, a sleep psychologist in London.
Other signs include forgetting the drive itself, she adds.
(Stock Photo) Signs that you are too tired to drive include yawning repeatedly, heavy eyelids and rubbing your eyes, feeling restless and irritable
'If you don't remember how you got home after driving or the turn-off that you have just taken, you are too tired to be driving.' And it's not just lack of sleep that can make us drowsy drivers.
Certain medications such as antihistamines and antidepressants can cause sleepiness.
Since March 2015, criminal penalties have been in place for drivers taking certain drugs — including benzodiazepines such as diazepam and lorazepam and morphine prescribed for anxiety, pain or depression — if they exceed a set threshold limit in the blood [although this is much higher than the normal prescribed dose].
Underlying health issues such as long Covid and sleep apnoea, which both cause sleep problems, are another problem.
According to the Sleep Apnoea Trust, 13 per cent of men and 6 per cent of women between the ages of 30 and 75 in the UK have sleep apnoea — where the walls of the throat relax and narrow during sleep, interrupting normal breathing and disrupting sleep.
Yet we are only treating about 10 per cent of patients who suffer with sleep apnoea, says Michael Oko, a consultant ear, nose and throat surgeon at United Lincoln-shire Hospitals NHS Trust.
There is a long list of 'notifiable' medical conditions which drivers are legally obliged to report to the DVLA — or risk a £1,000 fine. These range from insulin-dependent diabetes and cataracts or age-related macular degeneration (AMD, the most common cause of sight loss in the elderly) if both eyes are affected; to stroke, depression and anxiety.
Those who hold class 2 'vocational' driving licences for lorries and buses must meet more stringent medical standards.
They have to reapply for their licence every five years after the age of 45 — supported by medical reports — and annually after the age of 65.
Doctors can inform the DVLA if they have reason to believe that a patient is ignoring medical advice not to drive and that their refusal to stop driving leaves others exposed to a risk of death or serious harm.
THE TOLL OF SLEEP LOSS ON OUR HEALTH
Puts your heart at risk
The occasional late night won't hurt — but studies show that sleep loss leads to an increase in levels of the stress hormone cortisol as a way of increasing alertness during the day, but this sustained rise in cortisol drives up blood pressure long-term.
A study earlier this year by scientists in the U.S. and Egypt, published in the journal Clinical Cardiology, suggested routinely sleeping five hours a night or less increased heart attack risk by 56 per cent compared to seven hours or more, because of the rise in cortisol.
Lowers your mood
Insomnia interferes with restorative slow-wave sleep — the period an hour or two into sleep where the body starts to 'recharge' the cellular components necessary for normal biological functions.
This sleep stage has been found to be crucial for maintaining the brain's ability to cope with the emotional ups and downs of day-to-day life.
A 2017 study, in the journal Lancet Psychiatry, found that insomnia doubled the risk of developing depression.
Expands our waistlines
Numerous studies have found that a chronic lack of sleep is linked to obesity. That's because it can cause an imbalance between leptin, the hormone that suppresses appetite, and ghrelin, a hormone which stimulates it. Ghrelin gets the upper hand, making you snack more next day.
Disrupts immune system
Sleep deprivation reduces levels of infection-fighting antibodies released by the immune system because these are replenished while we sleep. For example, a 2022 University of Helsinki study found that insomnia increased the risk of hospitalisation with Covid-19 by 50 per cent.
Ruins sex life
A recent study of young men (18 to 30) in Peru found that those suffering frequent bouts of insomnia were six times more likely to have erectile dysfunction than their peers who slept well most nights, according to results in the journal Frontiers in Public Health. One reason may be a drop in levels of testosterone, which tend to peak while men are asleep.
Makes you meaner!
Insomnia makes you less kind, according to a 2022 study by University of California scientists in the journal PLoS Biology. Sleep disruption decreases activity in parts of the brain involved in empathy and pro-social behaviours, such as donating to charity.
by PAT HAGAN
AdvertisementOtherwise, the driver remains legally responsible to tell the DVLA if there is an issue.
Age may make a difference, too.One study by Harvard Medical School in the U.S., suggested older people may struggle to sleep as well as they did during their youth because they start to lose part of the brain that helps them 'switch off'.
The suggestion is that older drivers — four million Britons aged 70 and over have a full driving licence — have slower reaction times and poorer eyesight, and are more likely to have other conditions that can affect driving.
Yet despite all this evidence, plenty of people still drive when they are tired — with disastrous consequences.
In 2020, Nigel Butler, from Sutton Valence, near Maidstone, Kent, crashed on the M26 killing two men, aged 22 and 44, who were in his van.
'Butler had suffered symptoms of excessive daytime sleepiness for a number of years,' a police spokesman said at the time of the subsequent court case.
'He was aware this was an issue but had failed to get medical help for the condition or notify the DVLA.'
In 2020, Warren Wright, a 34-year-old teacher, was killed when Stephen Sheppard, who had sleep apnoea, is said to have fallen asleep at the wheel.
And then, of course, there was Rosie.
Alex first met her on a night out in Lincoln in November 2017.
'When I first saw her, I thought she was stunning,' he remembers. 'Rosie just had this aura of natural beauty; she didn't have to try. She was fun, so easy-going.'
He proposed on Rosie's birthday, November 27, 2020 — putting the engagement ring on their cocker spaniel Teddy's collar for her to see.
Alex is still struggling to come to terms with what happened and the outcome of the court case.
Jackson was sentenced to 18 months in prison and banned from driving for three years and nine months.
'He could have been given 45 years — what's the difference? It doesn't change my life, it won't bring Rosie back,' says Alex, who is now campaigning for greater awareness of the dangers of driving while tired.
'There should be police checks at night and in the early hours, pulling people over to make sure they are fit and able to drive.
'We need to get the message across: don't drive when you're tired because it can — and does — kill.'
Joanne Brine, a partner at JMW Solicitors LLP, who is representing Alex in a civil claim against the driver, points out that while the dangers of drink-driving and using a mobile phone at the wheel have been well highlighted and those behaviours have become socially unacceptable, 'driving whilst tired has not been given the same focus'.
'Drivers should bear it in mind particularly at this time of year when people returning from holidays may be planning to drive back from the airport after a long-haul flight, or drive to and from holidays or music festivals at unsociable hours,' she says.
So what steps should you take to prevent tiredness at the wheel and ensure you safely reach your destination?
Dr Hall suggests avoiding driving during the small hours of the night or in the mid-afternoon when our bodies naturally crave rest because of the circadian rhythm.
'Stay hydrated with water and opt for light, nourishing snacks to maintain steady energy levels without inviting a post-meal crash,' she says.
'Keep your car environment cool to fend off that sleepy warmth and engage your mind with an interesting podcast, music, or a conversation with a passenger.'
If you feel tired, napping either before a long journey or pulling over for a short nap is crucial, adds Professor Leschziner.
'A short nap — no longer than 20-30 minutes — can get you the sleep you need to feel refreshed,' he says.
'But avoid any longer — you'll fall into deep sleep and will feel very groggy when you wake up, which will affect your ability to drive safely.'
For the perfect nap, have a coffee beforehand.
Research in 2014 by Loughborough University found that those who had a 'coffee nap' — drank a cup of coffee and then immediately took a 15-minute nap — had fewer errors when driving a simulator than those who only drank coffee or only took a nap. The caffeine also helps prevent you napping too long.
Alex urges anyone planning to push on despite feeling tired during a journey to think about what happened to Rosie.
'I want people to remember what happened to her, how it happened, and to stay away from the car if they feel tired,' he says.
'No journey can ever be worth this kind of appalling loss.'
References
- ^ Angela Epstein (www.dailymail.co.uk)